Evidence map›Paper›PMID 41048875›Full record

ArticleTobacco prevention & cessation2025

Cue-Restricted Smoking as a behavioral adjunct for smoking cessation: Observational sub-analysis of a randomized trial of deep transcranial magnetic stimulation.

Jaqueline R Scholz, Bianca B Bellini, Sara D V Ziotti, Tania O Abe, Debora Arnaut, Rodrigo L Alberto, Marco A Marcolin, Serena Tonstad

Registry-linked trialAbstract read
In one paragraph

Article in Tobacco prevention & cessation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03264313 (A Prospective, Placebo-controlled, Randomized, Double-blind Study to Evaluate the Safety and Efficacy of the Use of Deep Transcranial Magnetic Stimulation), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03264313 naunknown statusnot on this map

A Prospective, Placebo-controlled, Randomized, Double-blind Study to Evaluate the Safety and Efficacy of the Use of Deep Transcranial Magnetic Stimulation (dTMS) on Smoking Cessation.

TypeinterventionalSponsorUniversity of Sao Paulo General HospitalRan2017 to 2020Enrolled100ConditionsSmoking Cessation, Transcranial Magnetic StimulationArmsDeep Transcranial Magnetic Stimulation
3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Jaqueline R Scholz *Department of Prevention and Rehabilitation, Tobacco Treatment, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Bianca B Bellini *Department of Prevention and Rehabilitation, Tobacco Treatment, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Sara D V ZiottiDepartment of Prevention and Rehabilitation, Tobacco Treatment, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Tania O AbeDepartment of Prevention and Rehabilitation, Tobacco Treatment, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Debora ArnautDepartamento de Neurologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Rodrigo L AlbertoDepartamento de Neurologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Marco A MarcolinDepartamento de Neurologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Serena TonstadCardiovascular Prevention Department, Oslo University Hospital, Oslo, Norway.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionCue-Restricted Smoking (CRS) is a behavioral technique for smoking cessation that has shown efficacy as an adjunct to pharmacotherapy. In CRS, individuals limit smoking to a standing position while facing a wall in an isolated environment devoid of sensory stimulation. This study aimed to assess the potential impact of CRS in a randomized trial evaluating deep transcranial magnetic stimulation (dTMS), which failed to show significant treatment effects.

methodsIn a randomized, double-blind, sham-controlled trial evaluating dTMS for smoking cessation, 100 participants were instructed to quit smoking by the end of week 1. None achieved cessation. Only 85 participants remained in the protocol beyond week 1 and received guidance to implement CRS during cravings. Cigarette consumption was monitored through self-report, exhaled carbon monoxide (COex), and plasma cotinine levels. Participants were categorized as: no reduction, additional reduction, or cessation. Joinpoint regression was used to assess longitudinal trends.

resultsThe 85 participants (68% male; mean age 49 ± 11.6 years) reported a mean of 31 ± 11.2 years of smoking. Beyond week one, 33% had not reduced their consumption, 8% showed a mild reduction, 43% a moderate reduction, and 15% a significant reduction; none achieved cessation. After CRS, 40% (95% CI: 29.5-51.2) reported further reduction, and 16.5% (95% CI: 9.3-26.1) achieved verified cessation by week 12. Joinpoint analysis confirmed significant decreasing trends in cigarette use and COex among the significant reduction and cessation groups.

conclusionsCRS was associated with clinically meaningful reductions in smoking and biochemically confirmed cessation. It is a low-cost, scalable technique that does not require intensive training or pharmacotherapy. This approach may be advantageous in low-resource settings. It warrants evaluation in larger randomized trials across diverse populations. CLINICAL

trial registrationThe study is registered on the official website of ClinicalTrials.gov. IDENTIFIER: ID NCT03264313.

Indexed as

behavioral techniqueCue-Restricted Smokingnicotine dependencesmoking cessationtranscranial magnetic stimulation

Identifiers

PMID41048875
PMCPMC12492311

What OpenQuestion holds

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LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.